Bloodless Peripheral Stem Cell Transplant

In 1996, Patricia
Ford, MD, a hematologist/oncologist at
the Joan Karnell Cancer Center at Pennsylvania
Hospital, became one of the first doctors in
the country to perform a bloodless
peripheral stem cell transplant. This procedure
was successfully performed on a patient diagnosed
with lymphoma.

This procedure was not only significant because it successfully treated
the cancer, but also because it provided a rare cancer treatment option
in the Philadelphia region.

The Bloodless Option
The bloodless option is available to patients
whose religious beliefs prohibit them from receiving blood transfusions
or blood products. Also, patients concerned about blood borne diseases,
such as HIV and hepatitis, may prefer the bloodless approach to
their treatment. In the past, these individuals have been denied
the option of peripheral stem cell transplant. The bloodless peripheral
stem cell transplant offers the option of aggressive treatment and
improved cure rates.

What are Stem Cells?
Stem cells live in the bone marrow. Bone marrow
is the soft inner part of the bone, which makes different types
of blood cells: red blood cells, which carry oxygen throughout the
body; white blood cells, which help fight infection; and platelets,
which help the blood to clot.

What is Stem Cell Transplant?
The stem cell procedure acts, not as the treatment
itself, but as a supplemental aid to standard treatments, such as
chemotherapy.

Patients diagnosed with certain cancers, such as myeloma, lymphoma or leukemia,
can have stem cells removed before undergoing intensive chemotherapy
treatment. While chemotherapy is designed to destroy cancer cells,
normal cells can also be damaged. Stem cell transplant replaces the
stem cells that are destroyed by intensive cancer treatment. The transplanted
stem cells help restore production of blood cells, which aid recovery
and helps improve outcomes.

The autologous or peripheral (blood found in the arteries or veins)
stem cell transplant is where the patient’s own stem cells are
removed, stored, and returned to the patient’s body after chemotherapy
treatment. Since the cells are not foreign to the body, there is less
chance for complications or rejection.

Eligibility
While a patient may request the bloodless option
based on religious or personal beliefs, there are other factors
to consider. Patients who are most eligible for this procedure include:

Patients suffering from myeloma, lymphoma
or leukemia.

Patients requiring high-dose chemotherapy as treatment.

Patients who are under the age of 70.

It is important to note that patients over 70 are not excluded from
eligibility. “If a patient is in good health,” said Dr.
Ford, “I would still recommend the peripheral stem cell transplant
procedure.”

In-Take Session
Once approved for the procedure, the next step
is the Intake Session. The Intake Session is required for both regular
and bloodless peripheral stem cell transplants. During the session,
the patient is evaluated by Dr. Ford and the Stem Cell Transplant
team. In addition to the medical evaluation, patients and their
families have an opportunity to meet the team, ask questions, and
receive additional information about peripheral stem cell transplant.

The peripheral stem cell transplant process takes approximately two
weeks. The following is a brief summary of what happens during that
time:

Week One
The first week begins with an outpatient process
called mobilization. The stem cells are mobilized by giving injections
of medications that stimulate the bone marrow to produce large numbers
of stem cells. This is followed by stem cell collection in which
a catheter is placed in the patient’s vein, blood is circulated
through a machine, which collects the stem cells and sends the blood
back into the body. This is done for four to six hours a day for
three days, though the length of time depends on the patient’s
height and weight. Afterwards, the stem cells are frozen in liquid
nitrogen, and stored with the American Red Cross until they are
needed.

Week Two
During the second week, the patient is treated
with high-dose chemotherapy. Following treatment, the stem cells
are returned intravenously back into the body. The cells generally
take about 2-3 days to settle back into the bone marrow. Within
two weeks, the cells settle, multiply, mature, and are released
into the body as red blood cells, white blood cells and platelets.
This brief time period is also the most difficult for patients.
As the hemoglobin count drops about five points, the potential to
develop anemia is at its highest.

According to Dr. Ford, patients generally experience significant
progress after two weeks, and fully recover within three months. While
the procedure can be exhaustive, the advantages of the bloodless approach
may include a faster recovery time, shorter hospital stay, reduced
blood loss, and elimination of the risk of blood contamination.

Follow-up
For patients and their families considering this
treatment option, the Joan Karnell Cancer Center offers stem cell
procedure reunions throughout the year. The purpose of the reunions
is to bring together prospective and former stem cell patients.

“It really is a team approach,” said Helen Grosky, LSW,
MSS, a social worker with the Joan Karnell Cancer Center. “Patients
considering this treatment are encouraged by those who have previously
been through the procedure.” If a patient does undergo this
treatment, Grosky adds that the Cancer Center provides post-treatment
support as well.

Today, the patient that Dr. Ford treated in 1996 has made a full
recovery and is living a comfortable life. Since the initial procedure,
Dr. Ford has treated more than 30 patients with cancer with the bloodless
approach. In addition, Pennsylvania Hospital continues to be one of
the few institutions in the country to successfully treat patients
with high dose chemotherapy followed by peripheral stem cell transplant
without the use of blood products.